Urinary problems

Some treatments for prostate cancer can cause problems urinating (peeing) and leaking urine.

Each treatment can cause different urinary problems, so ask your doctor about the possible side effects of your treatment. Your chances of getting each side effect will depend on the treatment you’re having, and on whether or not you had urinary problems before starting treatment.

Tell your doctor or nurse if you have any urinary problems. They can suggest treatments and lifestyle changes that can help manage or even stop these problems.

Urinary symptoms can also be caused by prostate cancer itself, by other prostate problems, or by a urine infection.

Contents

Watch Paul's story for one man's experience of managing urinary problems after prostate cancer treatment:

Problems after surgery (radical prostatectomy)

Surgery can cause urinary problems, including:

Leaking urine

This is the most common urinary problem after surgery. When you wake up after surgery, you’ll have a thin tube called a catheter in your penis. This allows urine to drain out of the body. Most men can’t control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.

You might just leak a few drops when you exercise, cough or sneeze (stress incontinence). Or you might leak larger amounts. Some men also leak urine when they get an erection or during sex.

What can help with leaking urine?

Leaking urine usually improves with time. It can be hard to deal with, but there are treatments and products that can help, as well as things you can do to help yourself.

Your treatment options will depend on how much urine you’re leaking, and how recently you had your prostate cancer treatment. Talk to your doctor or nurse about treatments and products that may be suitable for you.

Absorbent pads and pants

These can be worn inside your underwear, or instead of underwear. They soak up any leaks and are usually very discreet, so people won’t know you’re wearing them. Services vary from area to area, but your local NHS service may provide some pads for free. Talk to your doctor, nurse or continence advisor for more information.

Pelvic floor muscle exercises

These can strengthen the pelvic floor muscles, which help control when you urinate.

Urinary sheaths (external catheters)

These look like condoms with a tube attached to the end, which drains urine into a bag. The sheath fits tightly over the penis and you can strap the bag to your leg – under your clothes – and empty it as needed.

Artificial urinary sphincter

This involves surgery to fit a small device that consists of:

  • a fluid-filled cuff that fits around your urethra
  • a balloon in front of your bladder
  • a pump in your scrotum (the skin around your testicles).  Artificial urinary sphincter 2014

The device lets you control when you urinate. The fluid-filled cuff presses the urethra closed so that you don’t leak urine. When you squeeze the pump in your scrotum, the cuff stops pressing your urethra closed so that you can urinate.

Internal male sling

This is a small piece of material that presses gently on your urethra to keep it closed and stop urine leaking. You’ll have an operation to fit the sling. It should be tight enough to stop urine leaking out, but loose enough to let you urinate when you want to.

Male sling 2014

Adjustable balloons      

This involves surgery to place two small fluid-filled balloons around your urethra. The balloons press on the urethra to stop urine leaking out – but you should still be able to urinate when you want to.

Adjustable balloons

Medicines

You may be offered a medicine to help keep the urethra closed, or to calm your bladder down. This can help to reduce leakages.

Read more about treatments for leaking urine.

Difficulty urinating

Some men may find it difficult to urinate after surgery. This is caused by scarring, which can cause the urethra to become narrow. This isn’t very common after surgery.

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Problems after radiotherapy

Both external beam radiotherapy (EBRT) and brachytherapy can cause urinary problems, including:

Some men may leak urine after radiotherapy, but this is less common. It may be more likely if you’ve previously had surgery for an enlarged prostate.

Radiation cystitis

Radiotherapy can irritate the lining of the bladder and the urethra – this is called radiation cystitis. Symptoms include:

  • a need to urinate more often, including at night
  • a burning feeling when you urinate
  • difficulty urinating
  • blood in the urine.

Symptoms can start within a few days of your first treatment. They usually begin to improve when your treatment ends. But some men get symptoms for several months. And some don’t get symptoms until months or even years after their final treatment.

What can help with radiation cystitis?

There are treatments that can help with radiation cystitis, as well as things you can do yourself.

Lifestyle changes

Drink plenty of fluids (1.5-2 litres, or 3-4 pints a day), but try to avoid fizzy drinks, drinks containing caffeine – such as tea, coffee and cola – and alcohol, as these can irritate the bladder.

Some men find that drinking cranberry juice helps. But you should avoid cranberry juice if you’re taking warfarin to thin your blood.

Bladder wash

This is a liquid medicine that coats and protects the lining of the bladder, making it less irritated. A small tube (catheter) is passed up your penis and fills your bladder with the liquid medicine. You then go to the toilet to empty your bladder.

Read more about treatments for radiation cystitis.

Urinary frequency and urgency

Some men find they need to urinate more often after having radiotherapy (urinary frequency). You may also need to urinate more often at night (nocturia). If this happens, it might help to drink less in the two hours before you go to bed.

You might get sudden urges to urinate that are hard to ignore (urinary urgency). And a small number of men leak urine before they can reach the toilet (urge incontinence).

What can help with urinary frequency and urgency?

There are treatments that can help with urinary frequency and urgency, as well as things you can do yourself.

Bladder retraining

Over time, this can help you hold on for longer and control when you urinate. Speak to your specialist continence nurse or physiotherapist for more information.

Medicines

Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks.

Percutaneous posterior tibial nerve stimulation (PTNS)

This is quite a new treatment that may help some men to urinate and leak urine less often. A low electrical current is used to affect the nerves that control urination. This can help stop the bladder from emptying before it’s full.

Botulinum toxin (BOTOX®)

Injecting BOTOX® into the wall of the bladder can help stop the bladder squeezing out urine before it’s full. This is quite a new treatment for urinary frequency and urgency and it’s not available in all hospitals.

Read more about treatments for urinary frequency and urgency.

Difficulty urinating

Some men find it hard to empty their bladder properly after radiotherapy – this is called urine retention. Radiotherapy can cause the prostate to swell and block the urethra, leading to urine retention. It can also cause the urethra to become narrow – this is called a stricture.

Chronic urine retention

Some men can still urinate a little, but can’t empty their bladder fully – this is known as chronic urine retention. The first signs often include:

  • leaking urine at night
  • feeling that your abdomen (stomach area) is swollen
  • feeling that you’re not emptying your bladder fully
  • a weak flow when you urinate.

Tell your doctor or nurse if you get any of these symptoms. Chronic urine retention is usually painless, but the pressure of the urine can cause the bladder muscles to slowly stretch and become weaker. This can cause urine to be left behind in the bladder when you urinate. You may be more likely to get urine infections, bladder stones, blood in your urine or kidney problems.

Treatments for chronic urine retention include:

  • a catheter to drain urine from the bladder
  • drugs (alpha blockers or 5-alpha-reductase inhibitors)
  • surgery.

Acute urine retention

This is when you suddenly and painfully can’t urinate – it needs treating straight away. If this happens, call your doctor or nurse, or go to your nearest accident and emergency (A&E) department. They may need to use a catheter to drain your bladder.

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Problems after high intensity focused ultrasound (HIFU)

You’re more likely to get urinary problems after HIFU if you’ve already had other treatments for prostate cancer. Possible urinary problems include:

  • difficulty urinating
  • leaking urine
  • urine infections.

Difficulty urinating

HIFU usually causes the prostate to swell for a week or two, so you’ll have a catheter to drain urine from your bladder until the swelling has gone. HIFU can also cause the urethra to become narrow, making it difficult to empty your bladder (urine retention).

Leaking urine

HIFU can cause some men to leak urine when they cough, sneeze or exercise (stress incontinence). This may be more likely if you’ve already had radiotherapy. There are ways to manage leaking urine.

Urine infections

Some men get a urine infection after HIFU. If this happens, you’ll be given a course of antibiotics to clear the infection.

Read more about urinary problems after HIFU.

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Problems after cryotherapy

You’re more likely to get urinary problems after cryotherapy if you’ve already had radiotherapy. Possible urinary problems include:

  • difficulty urinating
  • leaking urine

Difficulty urinating

Cryotherapy can cause the prostate to swell, making it difficult to urinate for a week or two. You’ll have a catheter to drain urine from your bladder until the swelling has gone. Cryotherapy may also cause the urethra or the opening of the bladder to become narrow, making it difficult to urinate (urine retention).

Leaking urine

A small number of men who have cryotherapy may leak urine. This is more likely if you’ve already had radiotherapy. There are ways to manage leaking urine.

Read more about urinary problems after cryotherapy.

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How can I help myself?

Urinary problems can affect your self-esteem and independence, as well as your work, social and sex life.

As well as the treatments described on this page, there are things you can do to help yourself. Making changes to your lifestyle can help, and there are practical steps that may make things easier. You may find the suggestions in our online fact sheet helpful.

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Who else can help?

Talk to your GP, specialist nurse or continence nurse – they can offer you practical and emotional support.

Our Specialist Nurses can answer your questions over the phone and go through ways of managing urinary problems with you. You can also speak to a nurse online. They can arrange for you to get an ‘urgent’ toilet card to show to staff in shops, restaurants and other public places. They can also arrange for you to talk to a trained volunteer with experience of urinary problems.

You may have a local support group where you can meet other men with prostate cancer or urinary problems. And you might want to join our online community – a place for you to ask questions or share experiences.

There's a list of organisations that can offer information and support in our online fact sheet.

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Questions to ask your doctor or nurse

  • Is the treatment I’m having for prostate cancer likely to cause any urinary problems?
  • What type of urinary problems might I get?
  • What should I do if I can’t urinate?
  • Will my urinary problems get better?
  • What treatments are available?
  • What are the risks and side effects of treatments for urinary problems?
  • What can I do to help myself?
  • Where can I get pads and other products?

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